This is our only Home. We want to engage society actively and constructively. Only by asking the right questions can we arrive at the correct answers.
There is no need for fear as we are only doing what we must. To be apathetic is to be selfish and derelict in our duty to our children and our children's children!
Huang Shoou Chyuan

Saturday, January 19, 2013

This is a suggestion to shorten the never-ending queues at the public hospital’s Accident
and Emergency Departments that may be worth considering. Sometimes the queues can be longer than 4-5 hours (
not exactly a first world standard?).

I
want to emphasise that obvious serious emergencies such as symptoms of heart
attacks and major trauma ( eg broken bones)- of course should go straight to the A
& E and I trust that the staff who do the triaging ( filtering) at the
reception will get the doctors to treat these immediately. It is the rest ie not obvious emergencies- eg
giddiness, fevers, pain here or there etc that I think may consider seeing the
GP or Polyclinic. If the doctors at the GP/Polyclinic then direct them to A&E as
they are deemed emergencies needing urgent and early intervention, then these should
get a 50% ( or whatever sum) discount. Hence the total sum of someone who sees
a GP + A&E ( referred) should be less than the flat fee of A & E (
direct self-referral). Eg Flat fee of A & E now ( approx $95), new amended
sum ( if accepted) should be ( $43 + $25-30 ( GP’s fees)).

I
did not add, that referred patients should join a fast-track queue also…Addendum (19.1.13- same day)Another non-emergency source of A & E attendance are the patients who go there to get referral to specialist clinics at the public hospitals. Referrals to specialist clinics from A & E and polyclinics are considered subsidised and enjoy discounts whereas patients referred by GP's are automatically considered as non-subsidised and pay ( often substantial) full rates even if the patients are obviously poor. Those who are referred by GP's , and who then try to appeal to be downgraded to subsidised rates have to go through a sometimes demeaning process where they are interviewed by Medical Social Workers who pry into household incomes etc to see if there are any rich members in the family etc and hence do not deserve subsidies ie the Means test. This is the subject of another letter to the press...

Click
here for the published letter ( which was edited slightly). Here

Below
is my original letter.

Cheers,

Dr
Huang Shoou Chyuan

Unabridged Letter

Dear
Editor,

I
wish to lend my support to 2 recent letters writers(Lower A&E fees for referred patients: Ms
Soh Ah Yuen ) and (Why non-emergency cases throng A&E departments:MsWong
Jee Kiat ) who suggested that patients referred to the Accident and Emergency
Departments ( A&E) of public hospitals ( by GP’s and polyclinics
respectively) should get a discount from the flat fee charged to patients who
“referred” themselves there directly.

This is a sound proposition as one of the major
reasons why patients (even emergency cases) need to wait for several hours
before being seen by attending doctors is that despite best efforts at triaging
patients at the reception area to identify patients who have life or
organ-threatening conditions (eg heart attacks; airway obstruction) , many
others with less dire emergencies but still require timely intervention
nonetheless ( eg semi-acute bleeding from internal organs) are left to wait in
the queue together with many who obviously do not have urgent conditions (eg
patients whose companies do not recognize GP’s Medical Certificates (MC); mild
diarrhoeas).

To incentivize patients to see GP’s and
Polyclinics first , patients who have been screened by doctors at family
clinics and polyclinics and deemed as emergencies that require urgent
intervention at public hospitals through admissions at A & E, should get
substantial discount from the said flat fee. This sum must be significant
enough or else the thought of paying at the GP’s followed by paying almost the
same A & E flat fee again if referred to A&E will not be any incentive.
I suggest 50% discount so that together with fee from the GP or polyclinic ( if
referred back) – will still be lower than the original flat fee.

The advantage in this system is that :

1.Many who would have otherwise joined the throng
at the A & E , would have been treated and followed up at the GP’s /
polyclinics with no untoward effects to themselves

2.Less non-urgent cases in the A & E queue
would allow more accurate triaging ( which is still needed) and more
expeditious treatment of whole range of dire to semi-urgent emergencies.

3.This also has added advantage of increasing the
work load at the GP’s ( which is good and may dissuade some from embarking on
non-conventional branches of medicines e.g. Aesthetics)

Other measures that MOH/MOM can consider include
not allowing companies to only recognize MC's from A & E and not those from
GP’s as the latter are bona fide SMC-qualified doctors.

A further disincentive ( but may not be
politically-palatable) may be to surcharge those who ( even by any stretch of
imagination) can consider themselves as having an emergency ( eg mild rashes
with no associated organ symptoms etc) .

Unfortunately, there will be an increase in
attendence at polyclinics who may need to beef up their staff numbers but their
consolation would be that they have contributed to emergency cases being better
treated at the A & E’s!

Saturday, January 12, 2013

The events at Punggol East
in the past days fascinates a neutral like me as they remind me of a period in
Ancient China (first and second century AD) when the great Han dynasty was
crumbling due to various reasons including palace intrigues by shadowy eunuchs
and inept emperors. The ensuing civil war threw out legendary figures that
remain forever etched in common folklore.

This period is
characterized best by Luo
Guanzhong’s classic novel “Romance of
the Three Kingdoms” . Click here , here and here. In attempts to resurrect the Han dynasty, 3 main
protagonists from the 3 rival states of Wei (North) , Shu-Han (West) and Wu (
South) played key roles in this troubled time:

1. Wei state’s Cao Cao, the
Prime Minister who usurped the authority of the Han by using the young Emperor
Xian as a puppet as he is kept like a bird in a “gilded cage” in his capital Xu
Chang

2.Shu-Han ’s Liu Bei
, who though only a shoe maker ,was popularly acknowledged as “royal uncle” as
he had royal blood and could trace his lineage to the Han emperor and hence had
legitimate claim to the throne and

3.Wu’s Sun Qian , who
though barely a teenager, was of great intelligence, foresight and rectitude.

All of us of course know
the complementary roles played by other legendary figures like Guan Yu (dietified
as a god), Zhuge Liang and Zhou Yu etc.

The horse trading reported
in the media of the present pre-election period at Punggol East brings to mind
what happened after the monumental battle at Chi Bi ( Red Cliff) when Cao Cao’s
800,000 troops were unexpectedly decimated by the numerically inferior troops
of the Sun-Liu Alliance. Even when Cao Cao and his troops were beating a
chaotic retreat back north, the alliance missed an opportunity to eliminate Cao
Cao decisively as Wu’s and Shu-Han’s strategists were already acting in
self-centered ways to prevent their fellow ally from becoming too powerful in
the face of a weakened Wei state. Each ally wanted to prevent one tyrant ( Cao
Cao) being replaced by another (their erstwhile ally) in the future.

Scholars opined that
Shu-Han ‘s strategist ,Zhuge Liang’s, assigning general Guan Yu to HuaRong Pass
knowing that the latter would let Cao Cao escape as a favour for past kindness
and Wu’s commander ,Zhou Yu’s, strategy of pushing the retreating Wei troops towards
Shu-Han forces are examples that none wanted to be the “bad guy” who kills Cao
Cao and then risk becoming the target for Cao’s successors’ revenge. Not
surprisingly, Cao escaped to fight another day.

Whether Worker’s Party (WP)
or Singapore Democratic Party (SDP) has greater right to the vacant seat will
be left to the ward’s electorate to decide. Most pundits feel that if both
contest, none will win (ie PAP wins). If WP alone contests ( I am disregarding
other parties who only play bit-parts), the chance is best but SDP would then
be faced with another rival party that will totally eclipse them in time to
come. If SDP alone contests, WP’s plan of domination in the East, which is but
another brick in their scheme to build up a truly alternative party, would be
delayed or even off-railed in the off-chance that SDP actually wins. SDP may
then start to jostle with WP to be the main alternative party. If both contest,
none wins but WP prevents the emergence of a upstart and SDP will attract scorn
as being the spoiler …

Game theorists and other
watchers have opinions about which is the dominant strategy and hence the most
prudent step for each of the 2 alternative parties, but I am content to watch
and see if my theory about what each party will do comes to fruition…

Monday, January 07, 2013

My opinion about the recent fiasco about the $2.05mil EC Penthouse is published in the Straits Times Forum today( Click here).

Part of the information in the letter was from this post from TR Emeritus ( click here)

The original letter is as follows:

Dear Editor

The recent sale of a
4349 sq ft Executive condominium (EC) penthouse for $2.05 million has raised
many questions that need to be answered.

The Executive Condominium (EC)
scheme was introduced in 1997 to cater to “sandwich class” Singaporeans who
have exceeded HDB’s income ceiling yet have difficulty affording private
housing.

According to HDB’s website, the
eligibility criteria for EC’s include being Singaporean and being part of a
family nucleus. More significantly, the average gross monthly household
income must not exceed S$12,000.

The
EC in question is CityLife@Tampines,a joint venture by 3
developers, Creative Investments (40%), subsidiary of Amara Holdings Ltd,
Singxpress Property Development (30%) and Kay Lim Realty (30%). This JV
successfully bid $233.5 million for the land when the tender closed on 10 May
2012.

According
to the commonly used Affordability ratio ie price of house ($2.05million) over
the annual income ($144000) the Price-to-Income Ratio, ie Affordability Ratio
is 14.2. Most property analysts will classify this as not affordable.

The
World Bank considers a ratio of 5 or under as affordable for local residents,
while the United Nations have set the standard lower, at 3 .

The
questions that immediately come to our minds include:

1. Does
HDB, MND or any other government agencies (ie regulators) exercise any control
over how the developers’ design and build the EC’s? If not, why?

2. Did
regulators approve Citylife’s plan for these penthouse units? If so, are EC
penthouses justified? If not, did Citylife contravene any rules?

3. Do
the regulators feel that Citylife’s developers fulfilled the spirit of the EC
scheme? If not, what are the consequences for Citylife?

What
irked me even more was when the same developers, when interviewed at the launch
of Citylife, claimed that they would continue to build more penthouses for
future EC projects! This was surely an act of impunity nearly akin to raising a
middle finger to an already incensed public!

About Me

I am a doctor.
Everyone,even doctors,has a say in how Singapore is run. (But saying is one thing and getting someone to listen is something else).
For the sake of society, someone has to push the boundaries and seek out the OB (Out-of-bound) markers. So why not me (or is it I)?
About comments:
While you are free to post your comments here, your comments do not represent my views. In the event that any of your postings are deemed to be offensive or unsuitable for public viewing, as the author of this blog, I reserve the right to remove them.
I am contactable at nofearsingapore@gmail.com